Universal Health Care

in the Philippines
Gains and Challenges
Enrique T. Ona, MD, FPCS, FACS ( Hon.)
Secretary of Health
 The Social Contract with the Filipino
People
“From treating health as
just another area for
political patronage to
recognizing the
advancement and
protection of public
health, which includes
responsible parenthood,
as key measures of good
governance.” – President
Benigno S. Aquino III
 Universal
Education
Health Care

Investing in
Filipinos,
especially the poor

Conditional Cash
Housing Transfer
The Republic of the Philippines
• Archipelagic surface area of
115,831 square miles, with over
7,107 islands
• Population: 92.3 M (as of 2010)
• Population growth rate: 1.82%
• Life expectancy at birth: F 73 ; M 67
• 80 provinces, 140 cities, 1,494
municipalities, and 42,026
barangays (villages)
• Top government health agency:
Department of Health (doh.gov.ph)
4
 Population Pyramid
Challenge of Attaining Demographic Dividend
 Economic Situation in 2010
• Steady economic growth since 2003
•
3000
Poverty incidence with minimal improvement, despite
favorable economic growth
GNI per capita (Current USD)

2500
• GDP per capita 2,587 US Dollars in 2012
2000
• Poverty incidence was 27.9% in 2012

1500

1000

500

’93 ‘95 ‘97 ‘99 2001 2003 2005 2007 2009 2012
6 Year
 Health Financing
Total Health Expenditures as % of GDP
National Government Local Government
Social Health Insurance (PhilHealth) Private OOP
5%
Others

4% 0.50% 0.50%
0.50%
Percentage of GDP

3%
2.30% 2.20%
2.20%
2%

0.40% 0.50%
0.40%
1%
0.70% 0.60%
0.60%
0.50% 0.50% 0.70%
0%
2010 (Actual) 2011 (Actual) 2012 (Estimated)
 Health Financing
• Neither Gov’t subsidy Source of Health Financing By Source, 2011
nor the NHIP have
adequately protected 11% 12%
the poor from financial
risk 15%

• 51 % PHIC Coverage 9%
53%
despite the 1995
PhilHealth law mandate
National Government
of 100% coverage of all
Filipinos in 15 years Local Government

Social Health Insurance

(PhilHealth)
 Health Situation in 2010
• Public health efforts fall short of MDG
commitments for 2015, specially those related to
maternal health
Maternal Mortality Rates Reported from
National Surveys, Philippines, 1993-2011

MDG Target: 52

Survey Sources, Varying Years

 Health Services in 2010
The poor have limited
access to quality
outpatient (Rural Health
Units) or inpatient
(hospital) facilities

Philippine Orthopedic Center, Manila

Fabella Memorial Hospital, Manila

Hospital bed to population ratio has
remained the same for 2 decades
Hospital bed to
population ration
Total Fertility Rate, Philippines**
(1991-2009)

*3.6-3.9
*3.4-3.7
*3.1-3.2 *3.1-3.4 *3.0-3.2

*95% Confidence Interval

**Rates reflect 3-year averages centering on the middle of the 3-year period
 UNIVERSAL HEALTH CARE
Provide financial
risk protection
Achieve the public
Secure access to
health MDGs quality care at
facilities

INTERVENTIONS OF CARE
Secondary Prevention
and Primary Care

Improved Health
especially for the
Poor and Vulnerable
 Roadmap to Universal Healthcare
Public Health Financial Risk Quality Care Health
Millenium Dev. Protection Delivery System Governance
Goals Achieved Improved Accessible Improved

• Reduce • Expand • Upgrade • Develop

Maternal PhilHealth and Health
and Child Coverage Improve Systems
Mortality • Improve Health • Maintain
• Control & PhilHealth Units and an
Eliminate Benefit Hospitals Effective
Infectious Package • Deploy Health
Diseases Human Regulatory
• Promote a Resources System
Healthy for Health
Lifestyle &
Prevent
NCDs
 Key Accomplishments:
Attainment of Public Health MDGs

Reduce Maternal and Child Mortality

• 80% children fully immunized in EPI (BCG,
DPT3, OPV3, Measles & Hep B) in 2013
• 57% mothers delivered in health facilities in
2011 vs 38.8% in 2009
• 2.1 M women of reproductive age provided
modern family planning commodities in 2012
• Passage of the Responsible Parenthood
Reproductive Health Act (RA 10354)
Passage of the RP/RH Law and Signing of the
Implementing Rules and Regulations
Fabella Memorial Hospital
 Key Accomplishments:
Attainment of Public Health MDGs

Control of Infectious (Age Old) Diseases

• 164,523 TB cases (91%) treated in 2012
• 27 malaria-free provinces out of 53 endemic
provinces as of 2012
• 4,656 HIV/AIDS cases provided treatment
• 12 filaria-free provinces of 43 endemic
provinces as of 2012
• 4 provinces, 5 cities declared rabies-free
 Key Accomplishments:
Financial Risk Protection

National Enrollment Rate

• 2010: 57.20 M (62%)

• 2011: 78.87 M (82%)
• 2012: 75.82 M (79%)*
• 2013 : 79.13 M (81%)*
• *5.2 M NHTS poor households - 20 to 25 M beneficiaries (100%
national government subsidy)
• Passage of the Sin Tax Reform Law (RA 10351)
• Provide premium subsidy for the near-poor
• Passage of the National Health Insurance Act of 2013
Advocacy and partnerships for signing of
Sin Tax Law

In Billion Php

21 Projected Incremental Revenues from Sin Tax Earmarked for Health

 Key Accomplishments:
Financial Risk Protection

Benefit Packages
• No Balance Billing (NBB) Policy – adopted in Sept. 2011
• 23 Case Rates Package – adopted in Sept. 2011
• Z - Benefit Package – launched in July 2012
• Expanded Z-Benefit Package – launched in Feb 2013
• Enrollment at “Point of Care”
Launching of PhilHealth Case Rates
 Key Accomplishments:
Access to Quality Health Care System

Health Facilities Enhancement Program

(2010-2013)
• 1,567 Barangay Health Stations upgraded (out of
16,038)
• 1,642 Rural Health Units upgraded (out of 3,074)
• 266 LGU hospitals upgrade (out 0f 734)
• 60 projects implemented (in 70 DOH hospitals)
Barangay Health Station in
Palo, Leyte
 SAN REMIGIO RURAL HEALTH UNIT, SAN REMIGIO,
ANTIQUE

FACADE DELIVERY ROOM

3rd class municipality with a population of 30,446

BUGASONG MEDICARE COMMUNITY HOSPITAL,
BUGASONG, ANTIQUE
MARCH 2013

A Level 1, 15- bed district

hospital catering to a
population of 118,860
 DOH REGIONAL HOSPITAL in BAYOMBONG, NUEVA VIZCAYA
FEBRUARY 2013

Operating Room Complex

A Level 2, 200- bed Hospital

 Key Accomplishments:
Access to Quality Health Care System
Human Resources for Health Deployment
Program
• 204 Physicians (Doctors to the Barrios) deployed
• 21,952 RNHEALS nurses deployed
• 2,738 Midwives deployed
• 40,851 Community Health Teams* trained and
deployed
*Composed of 5 members with Nurse/Midwife as leader with 4 other members such as the Social
Welfare Devt Officer, DepEd School Physician, PhilHealth Advocacy Officer, Bgy. Nutrition Scholar,
Population Officer, Barangay Health Worker, Traditional Birth Attendant, or Parent Leader; assigned to
100 households per team to provide key messages and basic preventive care
Doctor to the Barrios
 Registered Nurses for Health
Enhancement and Local Service
(RNHeals)

22, 500 nurses are deployed annually

 Key Accomplishments:
Health Governance
DOH ISO 9001:2008 Certification
• First National Agency to be fully ISO Certified

Sincerity Rating
• DOH Satisfaction Rating - from “Good” (+37 points) to “Very Good” (+60 points)

Health Information Systems Improvement

• National Telehealth Service Program
• Wireless Access for Health
Partnership with private sector
• Health Leadership and Governance Program - improving governance at the Local
Government level
• Philippine Orthopedic Center
• Dialysis Services in DOH hospitals
 WAH M OBILE M IDWIFE

WAH SYNCHRONIZED PATIENT A LERTS

BY SMS (SPASMS)
 Universal Healthcare Targets by 2016
Pubic Health MDGs
Achieved Quality Health Minimal
Services Financial Risk
• Decrease Maternal MR to • Upgrade and • Enroll and cover
50/100,000 construct 95% of all
hospitals, RHUs, Filipinos with
• Decrease Under 5 MR to
25.5/1,000 BHS PhilHealth
• Modernize especially the
• Decrease TB prevalence to
equipment poor
387/100,000
• Increase health • Increase the
• Maintain low HIV/AIDS
prevalence (<1% of pop’n) manpower and support value of
drug access
PhilHealth claims
• Decrease malaria morbidity (and decrease
to 6.6/100,000
Out of Pocket)
 Gaps and Challenges
Difficulty to synchronize public health in a devolved and
fragmented health system
Bringing care in geographically isolated conflict and
disadvantaged areas
Implementation of rapid health insurance coverage to
about 40 million Filipinos thru national subsidy(50% of population)

Reform governance of public hospitals

Improve timeliness and accuracy of national data
gathering (eg. Vital civil registries)
Resistance to Public Private Partnerships

Frequent natural and man-made disasters

Bohol Earthquake (October 15, 2013)
Super Typhoon Yolanda
Super Typhoon Yolanda
Typhoon Sendong (Cagayan de Oro, Dec, 2011)
Zamboanga Siege (September 9, 2013)
Typhoon Pablo (Mindanao, December 5, 2012)
THANK YOU!